19. Sexuality in SCI

Actionable Nuggets for SCI (2nd ed., 2013)

The Problem:

Depending on lesion level, a variety of disruptions to sexuality, sexual functioning and fertility may occur after spinal cord injury (SCI). Issues often arise after discharge from the rehabilitation setting, some of which can be addressed in primary care, and others that require specialized expertise. The majority of individuals with SCI report that sexual function is important to quality of life, and have had at least one sexual relationship post-injury.

Actionable Nugget

Sexual activity, sexual function and reproductive issues should be addressed as part of an annual examination.

Evidence-based Best Practice:

The family physician should be prepared to have candid preliminary discussions about issues and expectations regarding sexual functioning and reproduction. Body image, sexual identity and options for sexual expression are issues for both sexes. Issues for men typically include: erectile dysfunction, anejaculation, retrograde ejaculation, potential for fatherhood, reproductive technology options. Issues for women typically include: birth control, frequent urinary and yeast infections, menstrual irregularities, fertility, menopause, pregnancy and delivery. Family physicians may wish to refer to a rehabilitation specialist for expert information on sexual and reproductive options.

There is evidence in favour of safety and effectiveness of Phosphodiesterase-5 inhibitors (PDE5i; eg., Viagra) for sexual dysfunction in individuals with SCI. Screening for cancer of sexual and reproductive organs should follow standard guidelines, but has been shown to be significantly below guideline levels. There is also increased risk for sexual abuse of patients with SCI who are dependent upon others (such as attendants or family members) for personal care.